Isolated Fournier’s Gangrene of Anterior Scrotal Wall and Penis : A Rare Case Report.

Abstract

BACKGROUND: Fournier’s gangrene (FG) is a rare and severe necrotizing fasciitis affecting the external genitalia, perineal, or perianal regions. Isolated penile along with sectoral anterior scrotal wall FG is an exceptionally rare clinical occurrence, with only a few cases documented in the literature.

CASE DESCRIPTION: We present an unusual case of isolated penile FG in a 78-year-old man without any co-morbidity except post- hospitalisation CKD. The patient presented with blackish discoloration and painful swelling of the shaft of the penis and sectoral anterior scrotal wall, without fever or any sign of sepsis. He was promptly treated with broad-spectrum antibiotics, followed by immediate surgical debridement. Once the wound bed was healthy, scrotal and penile reconstruction was performed using an unexpanded, meshed, split-thickness skin graft. The recovery was uneventful, resulting in satisfactory cosmetic outcomes.

DISCUSSION: FG is a rare, rapidly progressing necrotizing infection of the perineum and genital area, with a high mortality rate of up to 50%. It is often caused by polymicrobial infection. Diagnosis is typically clinical, although radiologic studies can be useful for assessing the extent of the disease. Clinical features of FG include sudden onset of pain, swelling in the scrotum, and wound discharge. Isolated penile FG is rare, with the corpora cavernosa often remaining unaffected. Its occurrence is generally related to sexual habits or traumatic injuries. The primary treatment approaches include rapid and aggressive surgical debridement of necrotized tissue, administration of broad-spectrum antibiotics, and early resuscitation.

CONCLUSION: Isolated sectoral anterior wall and penile FG is an exceptionally rare condition with only a few reported cases. Early and thorough debridement of all necrotic tissue is crucial for successful treatment.